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HomeMy WebLinkAbout528-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOL~ N.Y. CERTIFICATE OF OCCUPANCY No....Z..3..~ ......... Date ..................................... J~¥.-.2~...., 19...~). THIS CERTIFIES that the building located at..e~.s..~.t,~ohsD~%.~d+t..~[u.to~og~e. Map No ...... .*..~.$.. ........... Block No....~.~.~. .............. Lot No ........ .$.$..$. ...................................................... conforms substantially to the Application for BuJldinfl Permit heretofore filed in this office dated ........................... ~O.~.~e~...~LC~.., 19..,~.., pursuant to which Building Permit No..*.~..~2~ ............. dated ........................ ~O~.(~Et]~.e,~...~..., 19..~.., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is .............. ................................................ i~.R 1~. A~ ..0~[~.. ,E. AI~, .D~r~ZLZ~G ............................................... This certificate is issued to ....Mansf. l~ld..S~an~,..~t~el, ......................................................... (owner, ~essee or tenant) of the aforesaid building. HOWARD FOBFI NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 528 Z Permission is hereby granted to: Safeway Deve lo p e.~.~ ...T::~te.....A/O.. · ..Ma.n mDG eld...Se~.~t ......... ~x...?C~ -~.- .. ·. Mo~.t a~k.. ~f ~. ............................ ................ ~i~.Z.e~ ~.-...-~,..~.~ ............................... to ...... ~.td...new.- ~wet~-ing. .......................................................................................................... at premises located at .,.~/~--...~h.S~....~ ................................................................................. pursuant to application daled ....................... ~O~e~......~ ............. 19...~., and approved by the Building Inspector Fee $..10~.00 .......... Building tnspector FOE~I NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'SI OFFICE SOUTHOLDI, /q. Y. Examined ....... / ..~.....r~.......~....j. ......... 19...~..~..~ , ~ Approved ...................... '.~ ................ 19.'.:.....Permit No..~....~.~ .... Application No.......~..E.'.'~..~ ..... (Building InspectOr) APPLICATION FOR I~UILDING PERMIT November are ............................................................ ly ............ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this location. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progress of the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuanoe of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. Safeway Developers Corp. Sec'y (Signature of applicant, or name, if a corporation) (Address of applicant) (P.O.Box 708~ Shirley) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Builder Name of owner of premises.....~z~.,..&..l~.s.,..~a~s.f.i.e.lcl...Seama~ .............................................................................. if applicant is a corporate, signature of duly authorized officer. (Name d/d titre of corporate officer) 1. Location of land on which proposed work will be done. Mqp No: ............................................Lot No: .................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..................................................................................................................................... b. Intended use and occupancy....g...~..e..~-.~; .......................................................................................................... 3. Nature of work (check which applicable): New Building....N.?.~ .......... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... ~ost $8000. ~ $10 4. Estimated ~ .............................................................. ~-ee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units .............. 0M ........... Number of dwelling units on each floor ....... 0t"~ ............... If garage, number of cars ....... ,.N..o.n.?. ........................................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .............................. 7. Dimensions of existing structures, if any: Front ............................ Rear ............................ Depth ............................ Height ............................ Number of Stories ............................................................................................................. Dimensions of same structure with alterations or additions: Front ................................ Rear ................................ Depth .............................. Height .............................. Number of Stories ................................ 8. Dimensions of entire new construction: Front ' ~Ot Rear brOt Depth 26! Height .....&.6 .................. Number of Stories ....... ODe .............. ].0~+0 scL. fto House 9. Size of lot: Front 80~ Rear 80~ Depth 200t 10. Date of Purchase ...J~l.e....1.9.56 ............................... Name of Former Owner ..... ~a;~.olcl,..~;:J,l~or~o~ .............. 11. Zone or use district in which premises are situated ................................................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? ................ N~O ............................... Mansfield Seaman-.. 170 Combs Ave., Wo~dme~Fr ~-0308 13. Name of Owner of premises ........................................ ^aaress ............................................ rnone ~NU ..................... Name of Architect ........................................................ Address ............................................ Phone NO ..................... . . Safeway Developers NOA¢ 1-7280 Name of aonrracror .................................................... ~aaress ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, c"1~-- ...... COUNTY OF ............................ ~' ~"' Safeway Developers CorpI, Dorothy Losee S, ec'y.&. Treas.. ¢ ................................................................................................. oeJqg auty sworn, aeposes and says that he is the applicant (Name of individual ~Jgfiin9 abplJcatibn) above named. He is the .................................. 0.O~.fl~ ................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly cu?horized to perform or have performed the said work and to make and file this application; that all statements contained Jn this application are true to the best of his knowled9e and belief; and that the work will b~ performed in the manner set fort h in ~pp[~cotion filed ,therew~h. , , Sworn to before me this ~ , ~%~ ~" ~ ~:c~'~ .~. ~ .~ ~ ~ ,, D Notc~ Public, .~...~.;.~.~.~.:~ ........... ,//...../ ......... C~ty ~,~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OF~:ICE SOUT,OLD, N. Exom ned ....... ......... Approved ........................................ 19 ........ Permit No. ........... ~.~.,.~.~.,. .. .r~ ......... .................. ................................... (Building InspectOr) Application No...~?.~....~... ..... APPL,CAT~ON ~OR ,U,,D~NG P~RM,T Date...!?..o..~. ?..~..~. ~..z:...~:9. ~. ~.?. ~..8. .................. 19 ............ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to .adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this location. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Budding Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progress of the work. e. No building'shall be occupied or used in whole or in part for any purpose whatever until .e Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuanoe of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or a Iterations, or for removai or demolition, as herein described. The applicant agrees to comply with all applioable laws, ordinances and regulations. Safeway Developers Corp. Sec'y (Signature of applicant, or name, if a corporation) ...Nomt~.uk.~iC;k~a.~.~...S~.i~,e.~,:.Z,,~; ..................... (Adc[r~ss or appdcant) (P.O.Box 708~ Shirley) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises.....~,~..~...}~4g,~...~c-~.~$.C.&e~d..,,Se~,t~e~ ............................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) I Location of land on which proposed work will be done. Map No: .: ..........................................Lot No: .................... E/B Strohson Read Cutehogue ' L.I. N.Y. Street and Number .............................................. .~ ....................... ~ ............. ~. .......... ' .................................... ~ .............. Municipality 2. State existing use and occupancy of p~emises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..................................................................................................................................... b. Intended use and occupancy...,.ff~;¢22¢-~/...-~?..~;~ ...................................................................................................... 3. Nature of work (check which applicable): New Building..~..G..~.. .......... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost.~..8..O...O..O..? ............................................... Fee .~...]:..0.. .................................................................................. (to be paid on filing this application) 5. if dwelling, number of dwelling units ............. 011.~ ........... Number of dwelling units on each floor ...... iDln. e ............... If garage, number of cars ....... .N..O...~.9 ........................................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .............................. 7. Dimensions of existing structures, if any: Front ............................ Rear ............................ Depth ............................ . Height ............................ Number of Stories ............................................................................................................. Dimensions of same structure with alterations or additions: Front ................................ Rear ................................ Depth .............................. Height .............................. Number of Stories ................................ 8. Dimensions of entire new construction: Front ......... ~.0.~ ............ Rear ........ ,,~.0...1 ............. Depth .....~..~...I .................. Height .....t0 .................. Number of Stories ....... gl'ia .............. '101+0 SCl.. f't,o Hotl~le 9. Size of lot: Front 80l Rear 80! Depth~.O...O..I. .................... 10. Date of Purchase ..,T.1,Up~...'I.9~7o ................................ Name of Former Owner .....Ha.P~.(1...JB~otn.~O~. ............... 11. Zone or use district in which premises are situated ................................................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? ............... [~O ................................ 13. Name of Owner of premlses.,~.~...~.~..~..i..e...];..~....~,~.~a..~.Address .~..Z.~.....~...~..m.'b..~....A..~..~...~..~/....~...~.~t~j~.~...~...~..~..~.~. Name of Architect ........................................................ Address ............................................ Phone NO ..................... Name of Contractor...~..~..f.~,W..~t..~:..?..e.~.l...O.~P.~.~...O..t:~d~J~ess ..~,O.X...~..O..f..~....~...b'.~..~..~...e.~....Phone NO,A..~....~...-.~8.O. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, ) S S ......................... F~t ....... I COUNTY OF ............................ ) ' _.~c~ Ll --r't / ~\~ Safeway ge~lopers Cor~ ~o~hV ~o~ ~'v ~5, . ./ ................................................................................................. bei~ duly sworn, deposes and says that he is the-~pp icant (Name of individual signing application) ~ above named. He is the ....................................... ~~ ........................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the_appli~tion filed therew~h. Sworn to before me this ~ t~ss°~ .,, ~/~ ~ ,~ ~, .......... C.~ ......... day < ..... .,~~ ....... .4 19 .......... f~c, s~o~ ~?Z~o(Signa~re of applicant)